Duplication of the cervical esophagus. An unrecognized cause of respiratory distress in infants.

Infants with respiratory distress demand prompt action and thorough evaluation for possible causes. An urgent but infrequent source of upper airway obstruction is a duplication cyst of the cervical esophagus. Standard references omit this diagnosis in the consideration of both respiratory distress and neck masses in infants. Two patients were admitted with respiratory distress and delayed recognition of a neck mass. Contrast and sonographic studies revealed a cystic mass displacing the trachea in each case. Careful excision promptly relieved symptoms, and histopathologic evaluation confirmed the diagnosis. Duplication of the esophagus can compromise the normal airway, thereby presenting with respiratory difficulty prior to recognition of a neck mass. X-ray studies demonstrating displacement of the trachea or esophagus due to a soft-tissue mass and documentation of a cyst by ultrasound will aid in establishing the diagnosis. Surgical principles include aspiration and excision of the mucosal lining, with preservation of the muscular coat and mucosal septum. Duplication of the cervical esophagus should be considered in the differential diagnosis of both respiratory distress and an enlarging neck mass in infants.